How to handle emergencies with braces

Thankfully, there are very few medical emergencies that are associated with wearing braces. There are a number of issues of concern that can arise while you are in braces though, and I will discuss the most common “emergencies” and what to do should they occur.

A bracket (or “brace”) has come loose A bracket that has released from a tooth is the most common concern we see. Brackets are the square metal or ceramic part of braces that are bonded to your teeth with adhesive. This adhesive is designed to release from the tooth if excess force is placed on the braces. This breakage can occur due to a large amount of light “taps” on the braces from chewing (even from foods that might not normally be suspected), or one or two sudden heavy collisions with crunchy, chewy, or tough foods. Patients most often report that they were not eating any chewy or crunchy foods when the braces came off, and we explain that it often takes a day or two before the brace moves and is noticeable. Weakening of the adhesive can accumulate over a period of time before the braces finally releases from an otherwise harmless bite into food (similar to the last “chop” that cuts a tree down). We also explain that the breakage is not necessarily a bad thing, as a stronger adhesive would rip enamel off the tooth with the braces- the release is actually a protective mechanism.

We understand that life happens, and will gladly repair the loose bracket. If we see a pattern of multiple braces coming loose, we will work together with the patient to identify eating habits that are contributing to the breakage. If the bracket is loose, but still attached to the wire, simply use your fingers, a q-tip, or a tooth pick to slide or rotate the brace until it is in a comfortable position. Call our office, and we will help you find the best time to re-attach the bracket.

A wire is poking your cheek. Occasionally a wire may deform, or move out of place and start to irritate a patients cheeks or lips. First, try using a q-tip (or the end of the plastic mirror handle that was included in your hygiene kit) to push the wire against your teeth or to a more comfortable location away from the cheek. A nail clipper can also trim many poking wires. If this does not work, use a small pea- sized piece of relief wax from your kit, and place it over the irritating piece of wire. If the irritation persists, call our office, and we will likely have to clip or re-position the wire.

A wire has broke, or a band is loose. If an arch wire has broke into two pieces, try to remove the broken part if it is loose. A light wire can often easily be pulled out of the mouth with just a light pull. If this cannot be done, try to keep the pieces in a comfortable part of the mouth, and call our office for a repair as soon as possible. If a band around a back tooth, or an expander has come loose, try lightly pushing it back onto the teeth, and call our office as soon as possible.

A colored or clear tie has come off a bracket. We call the small rubber rings on your braces ligatures, and occasionally one may come off. If everything else appears in place and you have an appointment soon, we will be able to place a new one at your upcoming appointment. If it will be more than a few weeks until your next appointment, call us and we will replace the tie.

Canker sores. Canker sores, or aphthous ulcers, can be very painful. They are usually not caused by braces, but the braces can irritate them and exacerbate the discomfort. These sores last about two weeks, and there is no known way to make them go away sooner. The best option is to keep the area as comfortable as possible. Try using over the counter topical anesthetic such as Orabase or Ora-gel, and apply as needed with a q-tip.

General tooth and gum pain soon after braces are placed. Discomfort is to be expected the first 4-5 days after braces have been placed. I tell patients to hang in there, they are not alone- this is very common the first week of wearing new braces. For sore teeth, eat a softer diet (mac and cheese, pasta, soup, smoothies…) until things start to feel better. Take Ibuprofen if and as directed by your orthodontist to help with the discomfort. If your lips and cheeks are sore from rubbing on the braces, roll up a small pea sized ball of comfort wax, and press it onto the braces near the area of discomfort.

Dr. Dan Rejman is the owner of Meadows Orthodontics in Castle Rock, Colorado. He is a board certified orthodontic specialist, and provides treatment with clear braces, traditional braces, and Invisalign.